The arms race over quick, convenient health care is heating up in Arkansas.
Doctors, retailers and hospitals have been opening urgent care facilities or walk-in clinics to lure patients with non-life-threatening injuries away from hospital emergency rooms in a trend that has been slow to arrive in Arkansas.
In November, HealthCare Express Management Ltd. of Texarkana, Texas, opened an urgent care center on Maumelle Boulevard in North Little Rock, just after opening one in Little Rock’s Otter Creek neighborhood in June. And more are planned, said Dr. Tim Reynolds, managing partner of HealthCare Express.
“We certainly did not go into Little Rock only to have two clinics,” he said recently. “So certainly there will be more in the Little Rock area.” He said he didn’t have a timetable for when the facilities will open.
In December, MedExpress of Canonsburg, Pennsylvania, opened an urgent care center in Conway, an event that followed the opening of three centers in northwest Arkansas beginning in July. MedExpress plans to open centers in Fort Smith and Russellville this year and possibly more, said Dr. Robert Maha, chief operating officer and chief medical officer.
Urgent care centers are promoted as providing treatment that is both less expensive and faster than ERs. There are about 9,000 urgent care centers in the United States, with about 500 opening annually over the past several years, according to the Urgent Care Association of America of Naperville, Illinois.
“This is market-driven,” Reynolds said. “This is a new generation of customers who grew up with Google and Wikipedia on their phone who said, ‘I’m not going to wait three weeks to see my doctor. … I want to do it on my time. I want to be seen today.’”
Wal-Mart Stores Inc. of Bentonville jumped into the express medical business last year. While it has been leasing space in its stores to health care systems for years, Wal-Mart started a pilot program in April for its own walk-in health clinics.
Wal-Mart charges $40 a visit; its insured workers and their dependents pay just $4. Wal-Mart now has 16 Walmart Care Clinics in Texas, South Carolina and Georgia.
“We’re certainly looking at growth,” said Jennifer LaPerre, Wal-Mart’s senior director for health and wellness . “We don’t have a defined plan yet for [2015], but … we hope that we’ll continue to see growth in the Walmart Care Clinic model.”
The Wal-Mart clinics are staffed with a nurse practitioner instead of a physician, which is a difference between an urgent care facility and a walk-in clinic. An urgent care center is staffed with a doctor, can perform onsite lab tests and administer X-rays and IV fluids.
Hospitals See Advantages
Ray Montgomery, CEO of the White County Medical Center in Searcy, said the hospital bought McAfee Urgent Care in Searcy last summer. Montgomery declined to disclose the purchase price. The hospital also operates its Immediate Care Clinic, which it opened a year ago.
CHI St. Vincent Health System has two urgent care centers in Little Rock.
“It’s not a new strategy for us,” said CHI St. Vincent Chief Operating Officer Chad Aduddell.
The health system’s CHI St. Vincent West Urgent Care in Little Rock opened in 2011 and sees about 50 to 60 patients a day.
Aduddell said CHI St. Vincent doesn’t currently plan to open more urgent care centers, but they aren’t “ruled out.”
“In terms of growing more, I don’t have any specific plans at this point, but it’s part of our consideration for the future,” he said.
CHI St. Vincent is one of the health systems that lease space from Wal-Mart for walk-in clinics in the retailer’s Supercenters. The Clinics at Walmart are operated by CHI St. Vincent in Little Rock, North Little Rock, Sherwood and Bryant. CHI’s first clinic in Wal-Mart opened in 2009. The clinics in Little Rock and North Little Rock see about 15 patients a day, while the other two clinics see double that number, Aduddell said.
It’s too early to determine the impact of the urgent care centers on ERs. Paul Cunningham, EVP of the Arkansas Hospital Association, said he hasn’t heard his members talk too much about the urgent care centers, which may still be too new to Arkansas for hospital officials to have an opinion.
The AHA doesn’t track the number of urgent care centers in the state.
Effects of the ACA
Dr. Ateev Mehrotra, a policy analyst at the nonprofit research organization the Rand Corp. of Santa Monica, California, said changes in health insurance may be driving some of the growth. While more people have insurance under the Affordable Care Act, the deductibles in many cases are higher.
“So when you’re looking at that option of going to the emergency department, it generates a lot of fear in people because it can be so expensive if you’re going to pay for that care out of your own pocket,” Mehrotra said. “So they’re looking for alternatives.”
Montgomery, at WCMC, said he hasn’t seen a drop in ER visits as a result of the rise of urgent care centers in the Searcy area. Those include Sherwood Urgent Care and a PrimeCare Medical Clinic. The hospital still has about 50,000 emergency room visits annually, he said.
He said the hospital’s emergency room officials recently started encouraging patients to go to urgent care centers if their conditions can be handled there. The patients are told that they could save money and that using the urgent care center would free up the emergency department for trauma or other life-threatening conditions, Montgomery said.
Treatment at an urgent care facility usually costs a fraction of the care at an emergency department. For example, a urinary tract infection or strep throat might cost $300 to $600 at an emergency room could be treated at an urgent care center for about $100. Urgent care centers usually take most insurance plans.
Urgent care centers aren’t bound by the federal Emergency Medical Treatment & Active Labor Act, which requires hospitals to provide care to people who need emergency health care.
Mehrotra is concerned, however, that urgent care facilities drive up total health care spending.
“My fear is a lot of people will go to an urgent care center instead of just staying at home” and letting minor illnesses take care of themselves with rest, he said.
A Focus on Customer Service
Reynolds, of HealthCare Express, was medical director of Wadley Regional Medical Center Emergency Department in Texarkana, Texas, in 2005 when he got the idea that people didn’t need to sit in the emergency department for hours for ailments such as sprained ankles or cuts.
“Back then, nobody knew what urgent care was,” Reynolds said.
He said his plan was to open a medical center where patients who didn’t have life-threatening conditions could be seen fairly quickly.
He also wanted to improve the service and give patients the feel that they were in the Ritz Carlton instead of a medical waiting room. He said that he makes customer service a priority, and amenities include free Wi-Fi and bottled water in the HealthCare Express Centers.
MedExpress, now in 11 states, was started by four emergency room doctors in West Virginia who noticed the long wait times and “thought there must be a better way to treat patients that weren’t having life-threatening emergencies,” said Maha, its COO.
Maha said the locations in Springdale, Fayetteville and Bentonville have been “very successful” but declined to release patient volume or financial figures.
Effort to Influence Price
Wal-Mart moved into the health care clinic arena about eight years ago when it began leasing space in its stores to health systems across the county. About 95 of those clinics are still open, but Wal-Mart wanted to have a greater impact on health care costs, LaPerre said.
It decided it needed to own health clinics “so that we can influence price much like we do in every part of our retail offering,” she said.
It hired Quadmed of Sussex, Wisconsin, to manage the clinics. Wal-Mart also plans to keep its tenant relationships with other health systems, LaPerre said.
Wal-Mart’s first owned clinic opened in Coppers Cove, Texas, in April and now is averaging about 25 patients a day.
The Wal-Mart clinics are staffed with nurse practitioners who can treat cough, flu and cold systems as well as administer immunizations. It also can handle wellness and preventive care as well as refer patients to a specialist if necessary.
She said determining the $40-an-office-visit price was a test. “We looked at the industry and we looked at the model and said, ‘What will our customers bear?’” LaPerre said.
LaPerre said about half the people who come to the clinics don’t have a primary care provider and the majority of patients pay in cash. “We view this as a tremendous opportunity to be able to service our customers who otherwise weren’t getting care,” she said.
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